Out of the Tunnel

When I was a psychology student, I learned about a phenomenon called “state-dependent learning,” based on the idea that our brains associate certain memories with specific environments, sensory experiences (smells, tastes, sounds, etc.), and internal experiences (emotions, thoughts, images, etc.). For example, if you study in a blue room, you’re likely to recall the studied material better if you take the test in a blue room or with something blue nearby. If music is playing when you fall in love, hearing that music again will take you back to those memories. The brain works by association, and certain associations bring up other associations.

This extends to emotions as well. If you’re happy, you’ll more easily recall happy memories. Thus it follows that if you’re depressed, it’ll probably be more difficult for you to recall happier memories. So, when you’re feeling helpless and resourceless, it’s harder to get in touch with resources.

And what happens when a depressed person seeks help from a mental health professional? Most of us therapists tend to ask our clients to talk in detail about their depression. Now, of course, that’s part of our task: to assess the level and history of depression. But an inadvertent side effect can be a deepening of the depressive experience as we bring it to the foreground. Indeed, a recent study shows that extensive discussions of problems, encouragement of ‘‘problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect lead to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time.

In recent years, we’ve learned that repeating patterns of experience, attention, conversation, and behavior can “groove” the brain; that is, your brain gets better and faster at doing whatever you do over and over again. This includes “doing” depression, feeling depressed feelings, talking about depression, and so forth. Thus we can unintentionally help our clients get better at doing depression by focusing exclusively on it.

To counter this effect, I like to use a method that I call “marbling.” My father owned several meat-packing plants, and early on I learned that marbling refers to the fat streaks embedded in the leaner meat in a cut of steak. It gives the steak more flavor. In a similar way, but with less cholesterol, in therapy I suggest marbling discussions and evocation of non-depressed times and experiences in with discussion of depressed times and experiences. This way, we don’t just evoke and deepen the depression, and we avoid losing contact with the depressed person by listening to her and being careful not to invalidate or minimize her suffering. By going back and forth between investigations of depressed and non-depressed experiences and times, the person who’s been depressed is reminded of resources and different experiences, and often begins to feel better during the conversation.

In his book Darkness Visible, William Styron, who almost killed himself while going through a serious depression because he’d become convinced that he’d never come out of that painful state, put it this way after he recovered: “Mysterious in its coming, mysterious in its going, the affliction runs its course, and one finds peace.” But in the middle of it, one often forgets that there’s any other place, or any experience other than unremitting bleakness and pain. It can be a lifeline to people in the midst of depression to have even a glimmer of the possibility that there will be experiences outside depression.

One of the first ways I suggest implementing marbling is to discover, with the depressed person, a map of her depressed times, thoughts, actions, and experiences, as well as a map of her non-depressed times, thoughts, actions, and experiences. This is like asking the person to join you as a co-anthropologist of her life so that she can help you not only learn about the contours and geography of her suffering, but also about her competence and better moments.

Let me give you an example. While traveling to do a workshop in another city, I was asked to do a consultation with a woman, Cindy, who was spinning her wheels in therapy. Cindy would get stuck in severe depressions regularly and would basically stop functioning, quit her job, and become dependent on her therapist, whom she’d call many nights during the week in the depths of despondency and desperate for help. This had happened with several therapists in different places in which Cindy had lived as an adult, and she was driving her current therapist to her wits’ end. The therapist told me, “I feel like Cindy is sucking the marrow out of my bones.”

I began my conversation with Cindy by asking what had brought her to therapy. She said she’d be fine, feeling confident and competent, and then she’d get depressed, losing her sense of confidence and sleeping until noon. There didn’t seem to be anything she or the therapist could do. The depressive episodes typically lasted about two months, after which the depressed feelings would begin to lift and she’d pick herself up and resume her life.

I asked Cindy to compare and contrast her more confident and competent times with her depressed times, and the following picture began to emerge.

During her depressed times, Cindy:

• Stayed in bed until noon
• Got up, but stayed in her night clothes
• Sat in her living room
• Ate breakfast cereals all day
• Did nothing
• Talked only to her therapist and one male friend (who was also depressed)
• If working and beginning to feel depressed, went to lunch alone
• Thought about how she was getting worse and how she might have to move in with her father and stepmother if she couldn’t care for herself, or even be committed to a psychiatric institution if they couldn’t care for her or got tired of her
• Took her shower and got dressed in the evening

During her confident and competent times, Cindy:

• Got up, showered, and dressed before 9 a.m.
• Went to work or met a friend for breakfast
• Did art or played music
• Spent time with her girlfriends
• Met a girlfriend for lunch if she was still working
• Gave herself credit for small or big accomplishments in the recent past (e.g., getting a paper and looking for a job, finishing an art project)

As we talked about this, Cindy began smiling at times, even while discussing her depressive experience. (I told her that I wanted to learn the Cindy way of doing a good depression, and this phrase seemed to tickle her. She also got a kick out of my naming her depressive experiences “Depresso-land,” and contrasting it with “Confidence/Competent-land.”

We often talk about “depression” as if it were a uniform experience, but although many depressed experiences share common features, they always occur in specific and particular ways for the person in front of us. The non-depressed features are also very particular and specific. But we’re so often focused on the suffering of depressed clients that we neglect to investigate and discover other experiences that don’t fit with their depression. In Zen and the Art of Motorcycle Maintenance, author Robert Pirsig said that when an artist draws a tree, he doesn’t draw the branches and the leaves. Instead, as he draws the spaces between the branches and leaves, a picture of the tree emerges. This resonated with me because that’s what I do when approaching depression. I’m interested in discovering and detailing non-depressed experiences, actions, thoughts, and experiences. That way, I learn about the person’s abilities, competence, and good feelings as well as get a sense of her suffering.

One Foot In

Working with people who are depressed requires a delicate balance. They’re usually lost in their depressive experience and perspective, so you have to join them in that experience and let them know you have some sense of what they’re going through. At the same time, you have to be careful not to get caught up in that discouragement and hopelessness along with them.

I think of it as having one foot in their experience and one foot out. I call this Acknowledgement and Possibility. It involves acknowledging the depressed person’s suffering, validating his felt sense of things, and inviting him out of that experience.

When people don’t feel heard, understood, or validated in their experience, they often appear “resistant” and uncooperative in therapy. On the other hand, if all one offers is acceptance and validation, it’s all too easy to help the sufferer wallow and stay stuck in his depressive experience.

I remember a client I had early in my psychotherapy career who’d come in week after week soaking up my kind acceptance, unconditional positive regard, and empathy. She’d get her weekly support session and then go back to her miserable life. During one session—it was probably about our 22nd—I heard myself saying, “So, you’re depressed again this week.” And realized I wasn’t really helping her.

Around that time, I began to study with the psychiatrist Milton Erickson, who had many creative ways of challenging the most difficult patients to move on and change. I began to incorporate some of his methods into my work and noticed that my clients were changing much more quickly than they had before. But I still liked the warm, kind, active listening I’d learned in my elementary counseling training and didn’t want to lose that respectful approach. So I combined the best of both worlds and created this Acknowledgment and Possibility method. It not only respectfully acknowledges the person’s painful and discouraging experiences, but also gives him a reminder that he isn’t always and hasn’t always been depressed. It can illuminate and prompt skills, abilities, and connections that can potentially lead the person out of depression or at least reduce his depression levels.

I came across a letter that Abraham Lincoln wrote during his presidency that illustrates his deft combination of joining and inviting. (Lincoln suffered from a lifelong tendency toward depression, or what was called melancholy in those days. He’d been close to suicide during two major depressive episodes in his younger years.) He found out that Fanny McCullough, the young adult daughter of one of his generals who’d been killed during the Civil War, had fallen into a depression that was lasting much longer than the usual grief period. She’d taken to her bed in despondency, and her loved ones were worried about her.

When Lincoln heard of her plight, he sat down and wrote the following letter. (Note: I’ve italicized some of the Acknowledgment and Possibility parts of the letter to highlight them.)

Dear Fanny,

It is with deep grief that I learn of the death of your kind and brave Father; and, especially, that it is affecting your young heart beyond what is common in such cases. In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares. The older have learned to ever expect it. I am anxious to afford some alleviation of your present distress. Perfect relief is not possible, except with time. You cannot now realize that you will ever feel better. Is this not so? And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you some less miserable now. I have had experience enough to know what I say; and you need only believe it to feel better at once.

What’s so moving about this letter is the kind and powerful way Lincoln joins with Fanny’s grief and validates her suffering while simultaneously inviting her out of it.

Three Techniques of Acknowledgement and Possibility

How do you join while simultaneously inviting? Here are three simple methods for putting one foot in and one foot out when talking with people who are depressed.

1. Reflect in the past tense. This technique may seem too simple, but it can have a subtle and helpful impact. It involves reflecting what the depressed person is telling you as if it has happened previously but is not necessarily occurring now. For example, if a person says, “I don’t want to see anyone,” you might respond, “You haven’t wanted to see anyone.” If the person says, “I’m suicidal,” you might say, “You’ve thought seriously about killing yourself.” In each of these responses, you’ll notice that the reflection is couched in the past tense.

Here are two statements that a depressed person might make, along with some sample “reflect in the past tense” responses.

Depressed person: “I’m afraid I’ll never come out of this darkness.”

Possible responses: “You’ve been really afraid.” “You’ve been feeling pretty discouraged.” “You’ve been worried you’ll never feel better.”

Depressed person: “Nothing will help.”

Possible responses: “Nothing has helped.” “You’ve tried a lot of things and haven’t felt better.” “You’ve been thinking that nothing will help.”

2. From global to partial reflections. The next technique for acknowledging and inviting at the same time is to reflect the depressed person’s generalized statements as more partial. When the person says something like “always,” “never,” “nobody,” “nothing,” “everybody,” or another global term, you can reflect her statement or the feeling she’s conveying but using more limited words, such as usually, typically, rarely, almost nobody, very few people, little, most everyone, and so on. Your task here is to help her feel understood, but at the same time to introduce a little space into the stuck place she feels herself to be in.

Your reflections can be less global than the person’s original statement in both time (lately, recently, these days) and quantity (most, very few, almost everyone, little, rarely). For example, if the depressed person says, “Nothing is helping,” you might respond with, “You’ve tried most everything and it hasn’t worked much.”

3. Validating perceptions but not unchanging truth or reality. To use this technique, acknowledge and validate the depressed person’s perceptions without accepting the fixed, objective truth or unchanging reality of those perceptions.

When people are depressed, they often have an unrealistically pessimistic view of life, so agreeing with that pessimistic perspective may further discourage them. But we can’t just dismiss the person’s felt experience and tell her that her point of view is wrong. This technique involves finding a crucial balance by joining with and validating the person’s felt sense of the way things are while separating those views from accepted reality.

To do this, use phrases such as your sense; as far as you can see; as far as you remember; the only way to handle this, in your view, was; and so on. The goal is to help the person feel heard and understood without joining in her distorted or discouraged conclusions.

Here’s another example of a statement a depressed person might make, along with some suggested responses.

Depressed person: “I’ll never get better.”

Possible responses: “You think you won’t get better.” “Your sense is that there’s not much hope.” “As far as you can tell, nothing’s been working and you’re afraid nothing will.”

Combining All Three Techniques

Of course, as you get more practiced at these techniques, you can combine two or three of them in the same reflection. For example, if the person says, “I’ve just got to kill myself. I can’t take this anymore,” you could use all three techniques in your response by saying, “So, you’ve really been so discouraged lately and suffering so much that killing yourself seems the best possibility for relief right now.”

However, if the person gives you the sense that she feels invalidated or that your response minimizes her experience or suffering, you can switch to another of the techniques or return to pure acknowledgment for a time, leaving out any of the possibility elements.

For instance, suppose the person says, “I can’t get up and going,” and you use the partial reflections technique and respond with, “Sometimes getting going is really hard for you.” What do you do if the person comes back with, “Not sometimes. Every damn day! You just don’t get it, do you?”

You could respond with, “Sorry, I didn’t mean to minimize what it’s like for you to struggle with this. And you’re right, I probably don’t fully get how things are for you. So, your sense is that you can’t get going pretty much every day.”

The person will often respond with something like, “Well, on the days I see you, I manage to get up, but the other days it just feels too hard.” And that is the beginning of possibility. Your task in using these techniques is to stay close to the person’s experience while introducing small openings into her discouragement and sense of hopelessness. She’ll let you know when those possibilities start to become viable and real for her when she begins talking about possibilities and change herself.

Inclusion

Another method of marbling is what I call “inclusion.” Have you ever had a client come to your office and say something like, “I can’t go on. I have to kill myself”? In the back of my mind, I’m usually thinking, “Wait a minute, why did this person bother to get up, get dressed, and put on makeup [or comb his hair], just to tell me they’re going to die?” The people who are truly committed to dying would probably stay home and kill themselves. They wouldn’t give us the chance to intervene.

So my sense is that even if the person has decided to kill himself, there’s another aspect of him that hopes that coming to see me will change his mind—that I’ll be able to say something that will give him hope or relieve his desperation.

A while ago, I heard a story about a study of people who’d jumped off the Golden Gate Bridge, intending suicide, but had been rescued or survived the attempt. The researchers were searching for something that might help them identify people at risk and prevent future suicides. They found one commonality among the survivors: on the way down from the bridge to the frigid waters below, almost all of them had some variation on the thought Maybe this wasn’t such a good idea. That indicates to me that very few people are 100 percent hopeless, even in the moments before their imminent death (or perhaps they’re even more ambivalent when things have gone so far).

The inclusion method tries to acknowledge and capture this complex experience using three techniques, which I’ll describe below.

Permission

In addition to feeling depressed, many people who experience depression feel that they’ve done something wrong, or are feeling the wrong feelings, or are thinking the wrong thoughts, or are just basically “wrong” in some fundamental way. One way to help them with this sense of wrongness is to give them permission to feel, be, or think the way they do—and not to feel, be, or think the way they don’t.

This means that there are two kinds of permission that can be helpful with people who are depressed: “Permission To” and “Permission Not To.” These two types of permission are reflected in the following statements: “It’s okay to feel depressed” and “You don’t have to have hope right now.”

This permission-giving takes the person off the hook for being wrong or not feeling or being or thinking something he doesn’t feel or isn’t being or isn’t thinking. It also allows him to stop trying to keep himself from feeling, being, or thinking something he finds he can’t readily stop.

Now I want to be clear here that the permissions I suggest are mostly about experience, not actions. For example, I wouldn’t say to someone, “It’s okay to kill yourself,” but instead, “It’s not unusual for people feeling as bad as you do to think about killing themselves. It’s okay to think that. It doesn’t mean you’ll act on it.” So there’s no permission for self-harming actions or actions that might hurt someone else.

In this vein, I once had a client come to me after a referral to another therapist had proven disastrous. Her old therapist had retired from practice and sent her to a colleague who he thought was very skilled. But on the first visit to this new therapist, the client, Mary, admitted to the therapist that she was in such misery that she considered suicide every day. Her previous therapist had known this about her, and given the fact that she’d thought about suicide for the whole 10 years and never acted on it, hadn’t really considered it an issue. But the new therapist, trained in the latest standards and concerned about liability, told Mary that if she wanted to continue in therapy with him, she’d have to sign a “suicide contract,” agreeing that she wouldn’t kill herself, or if she felt she couldn’t keep the contract, that she’d inform him immediately so she could be committed to a psychiatric hospital.

A suicide contract is a pretty standard and reasonable idea, but for Mary, the effect was instant and bad. After she reluctantly signed the agreement, her suicidal impulse, always present, became a compulsion. She now felt compelled to kill herself right away. She called the old therapist to tell him she’d signed the contract under duress and that she’d like to renege on it.

The new therapist refused to allow this, and when she told him she couldn’t continue in treatment with him under those conditions, he sent her a certified letter recommending that she check herself into the hospital immediately. This letter further alienated her from him, since she saw it as a “cover your ass” kind of letter. It was all about him, and he didn’t get how this policy of his was harmful to her and had put her life in danger. She called her previous therapist, asked for a new referral, and was given my name.

When she explained to me the effect of the contract, I asked her what about signing the contract had made suicide so compelling. She told me that she’d always had that as her escape hatch if things got too bad, and signing the contract had closed that escape hatch and made her desperate. I told her that since she’d been suicidal for all of 10 years and hadn’t acted on it, I wouldn’t be needing such a contract, and treatment continued on without that becoming an issue ever again. She had permission to have suicide as an option. Notice I didn’t give her permission to kill herself, just to have that escape clause available in her mind.

Again, here are some examples of suggested permissive responses.

Depressed person: “It’s all meaningless.”

Possible responses: “It’s okay not to have meaning right now.” “You don’t have to know what it all means right now. We’re just working on how to get you feeling better today and tomorrow.”

Depressed person: “I feel hollow.”

Possible responses: “It’s okay to feel hollow.” “Feeling hollow is pretty common for someone who’s depressed. You don’t have to feel any other way right now.”

Inclusion of Opposites

The next way to give permission is more complex and nuanced and may be especially helpful for people who are depressed. It involves giving permission to have two opposite feelings or to be two ways at once. For example, someone may feel like dying and also want to live. Or he may feel like killing himself but not want to hurt his family and friends by killing himself. A person may consider himself optimistic but also pessimistic. Or generous and selfish. Or sane and crazy.

This technique, then, involves giving the depressed person permission to include, feel, or be those contradictory things simultaneously. You might say, “You can be hopeless and have hope at the same time” or “You’re all messed up and you’re okay.” It’s as if the person is trying to fit two feelings or two aspects of himself through a door and has gotten stuck. This inclusion technique makes a double-sized door to allow both aspects or feelings to coexist without conflict or choosing which one is right. One major way to communicate this is to connect the two contradictory aspects with the conjunction and. The word and signifies inclusion of both, whereas the conjunctions but and or imply one or the other.

“You felt as if you couldn’t get out of bed today, and you got up and came to see me.”

“You wanted to give up, and you wanted to keep going.”

“You feel as if there’s is no end to this, and you think you’ll come out of it.”

“You’re down on yourself, and you have compassion for yourself.”

“You can’t find your sense of meaning, and you think you’re going through this depression for a reason.”

“You don’t want her to leave you alone, and you don’t want her with you because you feel so ashamed and nonresponsive.”

“You can’t sleep, and you’re exhausted.”

“You don’t want to die, and you don’t want to live like this.”

“You don’t want to actively kill yourself, and you find fantasizing about dying comforting.”

You might have to stumble around with this before you hit on the inclusive reflection that really moves the person, helps him feel both understood and validated at a deep level, and perhaps helps him shift in some way. This technique can be challenging because this isn’t a logical way to speak or think, at least for most Westerners (non-Westerners may have an easier time with it.)

Oxymorons

In the English language, we have a natural way to use inclusion called the oxymoron. This is when two opposite concepts are put together in a two-word phrase, such as sweet sorrow or exquisite suffering. A more expanded way of using oxymorons is to spread them apart in a sentence or phrase; this is called the apposition of opposites.

“It’s important to remember to forget certain things and not to forget to remember other things.”

“It seems that you’ve spent so much time in darkness that your eyes have adjusted and can see things in the dark that others can’t.”

“You’re hoping against hope that this depression will lift.”

As you can see from the above examples, there can be a place for using oxymorons in therapy to emphasize that it’s okay and even beneficial to have conflicting perceptions and experience opposing ideas. One last application of the inclusion of the opposites technique is to include the negative with the positive by using tag questions. Tag questions are little questions added on to the end of a statement that seem to say the opposite.

Milton Erickson once told me, “If you can’t say the ‘no,’ the patient has to say it.” He regularly used these tag questions. Here are some examples:

“You don’t think you’ll get better, do you?”

“You’re not feeling better, are you?”

“You’re starting to feel better, aren’t you?”

If you think of the Asian symbol of the yin yang, you will get this technique. There is a yes in the no and a no in the yes, and they complete each other to make a whole. The point of this method is to help people become more integrated, including all their aspects, so they feel less fragmented or troubled by the disparate aspects of their experience, feelings, or personalities. Without this integration, clients often feel ashamed or torn in two directions, which can increase their emotional distress and deepen their depression. Here’s another example.

Depressed person: “I feel like I’m falling through the floor and there’s no bottom. I just keep falling.”

Possible responses: “You haven’t found the bottom of the bottom.” “You’re afraid things will get worse without stopping, and you’re hoping we’ll find a way to stop your descent. Is that not right?”

Exceptions

Very rarely is someone always depressed, or always empty, or always without energy, or always suicidal. If you and the person you’re helping explore exceptions to the usual problem, feeling, or thought, you can usually find moments when it’s not occurring. A lot can be learned from these exceptions that may be helpful in finding relief from the depression, so here we’re just trying to do some marbling by acknowledging that there are exceptions to the rule of whatever the person’s complaining about or isn’t working for him. For example, he has no energy (except when he does). Or he can’t get out of bed (except when he does). He feels bleak (except when he doesn’t). He never laughs anymore (except when he does).

What I’m pointing out is that life and people are more complex than we sometimes think or acknowledge. Remembering and recognizing that complexity helps us keep our perspective. Rarely is a situation all one way or all the other. Rarely is a person only one way. Of course, we have to be careful with this technique, as it can be invalidating or sound flippant or glib. For example, if the depressed person says, “I can’t get out of bed,” and you respond with, “Yet you got out of bed to get to my office,” it probably won’t have the validating and expansive effect that this technique intends. Rather, this technique mostly involves listening carefully and choosing the right moments and words to highlight the exceptions in a respectful way. I listen for reports of things that have been better or different from the usual problem in the recent past.

For example, if the person says, “I did better the first few days after I came in last week, and then everything just fell apart again,” I ask him what he felt or experienced during those first few days before I ask about what happened when he fell apart. If the depressed person has been adamant about giving up and killing himself and then starts talking about his plans for some future event, this indicates that there are moments when he’s thinking about being alive in the future. Acknowledging this exception may merely involve asking more about those future plans.

Here’s an example of a client–therapist interaction in which the client talks about his depression but indicates that there’s more to the story than just depression.

Client: “Sometimes I just feel so hopeless. I don’t know if I’ll ever come out of this hole I’m in. Maybe getting this new job will help. My old job just sucked.”

Therapist: “When you’re afraid you won’t come out of it, it seems hopeless, but when you think about this new job, you get some sense of hope.”

One specific way to discover and highlight exceptions is to listen for and acknowledge moments of non-depression. Perhaps the person got absorbed in a movie and “forgot himself” for a few hours. Perhaps he spent time with a friend or family member and felt better for a time. Perhaps there was a time in the recent past when, inexplicably, his depression was better for a day, a week, or longer.

Another way to find exceptions is to find out about what happens when the depression starts to lift that’s different from what happens during the depressive episode. Maybe the person starts to become more social, or listens to music more, or goes out of the house or eats different foods. Of course, one way to find out what happens when the depression starts to lift is to listen for reports of those times, but you can also elicit such reports by asking about them directly. Here’s an example of such a direct elicitation: “I’m curious. You’ve been through these times of depression before and have come out of them. What happens when you start to emerge from that darkness and begin feeling better?”

One last way to discover exceptions is to investigate why the depression isn’t worse or the person isn’t less functional. This is sort of a backward way of discovering exceptions. For example, you might ask your client, “How have you been able to go to work or visit with friends when some people with depression haven’t been able to do those things?” Or, “What’s stopped you from acting on those suicidal thoughts?” Or, “Why haven’t you given up on seeking help?” The answers to these and similar questions can contribute to the marbling.

Obviously, one has to ask these questions and investigate this area with a great deal of sensitivity. You don’t want to imply that the person needs to be doing worse before he can convince you that he’s really suffering or that he has to reach the depths of suffering that others do. Instead, you’re trying to awaken in him an appreciation for the times and parts of his life that aren’t so dysfunctional.

Here’s an example of the kind of inquiry you might make: “I was a little surprised to hear that you finished that big project at work even though I know you’ve been feeling like hell. If I were talking to someone else who was depressed and had a similar kind of project in front of them, what would I tell them about how you were able to pull that off even though you felt so impaired?”

Depression as a Bad Trance

I learned hypnosis many years ago when I began to recognize some similarities between a hypnotic trance and what I began to think of as a “symptom trance” or “problem trance.” Both types of trances often involve a narrowing of the focus of attention, and the induction of both involves rhythmic repetition. In Sense and Nonsense in Psychology, Hans Eysenck tells a story about a young English surgeon, just about through with his training, who was drafted into the army during World War I and sent to fight on the fields of France. On the battlefield, he came across a French soldier severely wounded by a mortar shell, writhing in pain and doing further damage to himself. The soldier was in imminent danger of dying unless the Englishman could get him to stay still until he could get him back to the surgical tent for treatment.

In desperation, the Englishman remembered a demonstration of hypnosis he’d seen during his medical training and decided to try what he remembered of hypnotic induction. But he didn’t know much French, so the best he could do was repeat again and again to the writhing Frenchman the only French words he could conjure up: “Your eyes are closing. Your eyes are closing.”

To his amazement, the Frenchman stopped writhing and his breathing slowed. He appeared to be in a trance that lasted long enough to get him back to the medical tent, where the British surgeons did indeed save his life. After the operation, the medical student told the British surgeons the story of his hypnosis. They all began laughing and told the baffled student that what he had really said was “Your nostrils are closing. Your nostrils are closing.”

What the story illustrates is that it was the repetition, not necessarily the correct words, that had the hypnotic effect. In a more insidious way, a similar process happens in depression. The depressed person repeats the same thoughts, activities, feelings, and experiences again and again and begins to become entranced. Only the trance is not a healing trance, a therapeutic trance, but a “depression trance,” which induces more and more depression as it’s repeated. Marbling can be an invaluable tool in breaking the depression trance.

This article is adapted from Out of the Blue: Six Non-Medication Ways to Relieve Depression by Bill O’Hanlon, copyright © 2014 by O’Hanlon and O’Hanlon, Inc., with permission of the publisher, W. W. Norton.

Photo © Paul Grand Image / Getty Images